Trauner, J.BTrauner, J.B2022-05-182024-04-152022-05-182024-04-151982https://hdl.handle.net/10566/10658Philosophiae Doctor - PhDIn the 1970s, traditional delivery patterns in medicine and dentistry began to change as health care professionals sought out new ways to attract patients and to increase practice earnings. Anesthesiologists and surgeons began to build freestanding surgical facilities in competition with local hospitals.1 Physicians trained in emergency or primary medicine established urgent care centers along well-trafficked thoroughfares and catered to patients usually seen in hospital emergency rooms. And, beginning in 1977, dentists began to establish high-volume offices in shopping malls and within the confines of drug, discount, and department. store operations. While the growth of independently owned, non-hospital affiliated surgery centers dates .back to the early 1970s, the major impetus for development of urgent eire centers and retail dental offices was the lifting of restrictions on use of advertising by health professionals. Until 1977, the ethical codes of most medical and dental associations prohibited advertising by their members and these codes had.been incorporated into state licensing requirements. Then in 1977, the U.S. Supreme Court decision in Bates Y. State Bar of Arizona (433 U.S. 350) paved the way for professional advertising. For the first time, health professionals could experiment freely with neM practice forms and use standard marketing techniques to attract potential patients. A new generation of entrepreneurial professionals established medical and dental offices with expanded hours of service and ·drop-in" (non-scheduled) visits to meet the needs of an increasingly mobile populationi some began to rely upon price advertising, introductory offers, and discount coupons. while others began to adopt trade names and develop franchising programs to increase their market visibility. Obviously these new developments were not ignored by local physicians and dentists--or by their professional associations. In states where advertising was regulated under medical or dental practice acts, professional associations monitored advertising copy and reported infractions to state licensing boardsi in states with minimal restrictions on advertising. physicians and dentists began to clamor for new guidelines. Two areas of heated controversy related to advertising of fees (including use of discounts) and the development of fictitious trade names. Another point of conflict involved expanded duties for para-professionals, particularly in dentistry where activities of hygienists and auxiliaries had been narrowly defined by many state licensing boards. In the case of freestanding emergency/urgent care facilities, the overriding issue was how they should be defined and regulated. For instance, should freestanding centers be required to have the same equipment and capabilities as hospital-based emergency facilities? Should they be integrated into local or regional emergency medical service (EMS) systems? To the extent that they were viewed as ·clinics· or ·institutional facilities"--rather than freestanding medical offices--they could be made subject to state licensing restrictions and to the Certificate of Need (CON) planning process mandated by the National Health Planning and Resources Development Act (P.L. 93-641). In the case of freestanding, independently owned surgery centers, the primary opposition came from the hospital industry; in states where freestanding facilities were required to be licensed and/or undergo CON review, the hospital industry regularly took an opposing position, arguing that additional surgical facilities would compound the problem of excess capacity within the health ' care system.enCertificate of Need (CON)Emergency medical service (EMS)Federal Trade Commission (FTC)American Dental Association (ADA)Health Resources AdministrationUrgicare centerFreestanding Ambulatory Surgery Association Health maintenance organizations (HMOs)National Association of Freestanding Emergency Centers (NAFEC)Ambulatory Care Center/Emergency Services System (ACCESS)Ambulatory Care Center/Emergency Services System (ACCESS)Joint Commission on Accreditation of Hospitals (JCAH)Metropolitan Statistical Areas (SMSA)sSociety for Office Based Surgery (SFOBS)University of the Western Cape